RelaxeyIn-Home Massage Inquiry And Booking Form

Please call 800-834-8350 or fill out the form below to book a session now.

Your Name:

Please Digitally Sign by Entering Your Initials Here:

E-Mail Address:

Cell Phone Number:

Is this your first time booking with Relaxey?

Are you booking a session for TODAY?

If not, what's the date of the session you're interested in:

Time of session:


Is this a couples massage or massage for an individual?

If you are requesting a specific therapist by name please enter the therapist's name here:

All our therapists are competent and among the top in the field. As Health Care Providers, we feel that gender is irrelevant. However, if you have a preference, please let us know. We wish to accommodate you, not impose our worldview.

What is the gender of the person(s) receiving a massage?

What region?

House Number and Street Name where the session will take place:

Town or City:

Neighborhood or Development:

Type of residence:

What floor will the session take place on?

What is the apartment or unit number or designation?

If there are special parking procedures, please state here:

Is there an elevator?

If the session is for someone other than yourself, please state the person's name and your connection with them.

Modalities you're interested in: (Please check ALL that may apply; multiple modalities may be combined in one session at no added cost, with the exception of Hot Stone.)

*Hot Stone is the only technique that carries an added surcharge.

Any technique/modality not stated? Please list here:

Anything else you'd like us to know to be prepared for your session? Include it here!

Would you like to pay now by credit card?

<-- (Please hit 'Submit' to continue.)